Home Healthcare Services
Home Healthcare for Medicare
Home healthcare means getting medical help at home when you're sick or hurt. It's usually cheaper, easier, and works just as well as going to a hospital or skilled nursing facility.
Coverage Details
Medicare Part A and/or Medicare Part B covers eligible home health services, including:
Medically necessary part-time or intermittent skilled nursing care
Physical therapy, occupational therapy, and speech-language pathology services (if you meet certain conditions)
Medical social services
Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time)
Injectable osteoporosis drugs for women who meet certain criteria
Durable medical equipment (DME)
Medical supplies for use at home
Medicare doesn't pay for:
24-hour-a-day care at your home
Home meal delivery
Homemaker services (like shopping and cleaning) unrelated to your care plan
Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
Eligibility
Medicare covers certain home health services if you require part-time or intermittent skilled care and are considered "homebound." This means:
You have difficulty leaving your home without assistance—such as using a cane, walker, wheelchair, crutches, special transportation, or help from another person—due to illness or injury.
Your medical condition makes it inadvisable for you to leave home.
You're normally unable to leave your home because it's a major effort.
In most cases, "part-time or intermittent" means you may be eligible for skilled nursing care and home health aide services up to 8 hours a day, for a maximum of 28 hours per week.
Provider Requirements
A healthcare provider, such as a nurse practitioner, must conduct a face-to-face evaluation to determine your need for home healthcare.
Your provider must formally order the care, and a Medicare-certified home health agency must deliver it.
If your provider recommends home healthcare, they should give you a list of agencies that serve your area. They are also required to disclose any financial relationships they have with the agencies they recommend.
Once you're referred, the home health agency will contact you to schedule an initial visit. During this appointment, the staff will discuss your needs and ask questions about your health.
The agency will coordinate with your doctor or provider to develop a care plan and keep them informed about your progress.
Home health staff should visit you as often as prescribed by your provider.
Costs
You pay nothing for all covered home health services,
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for Medicare-covered medical equipment.
Home Healthcare for Individual and Family Plans
Individual and Family plans typically cover medically necessary skilled home healthcare, but often exclude non-medical personal care. The extent of home healthcare coverage under your plan is outlined in the plan’s summary of benefits.
Services potentially covered
For home health services to be covered under most individual plans, a doctor must determine that they are medically necessary for treating an illness or injury. Covered services often include:
Part-time or intermittent services from a licensed nurse, such as wound care, injections, intravenous therapy, and medication management.
Physical, occupational, and speech-language pathology services aimed at helping you recover and regain independence.
Medical social services
Part-time or intermittent care to assist with daily living activities (e.g., bathing, dressing) but only if you are also receiving skilled nursing or therapy services.
Durable medical equipment (DME) and medical supplies
Services typically not covered
Most private Individual and Family plans don't cover services that are non-medical in nature. These frequently include:
Help with daily living activities when it is the only care you need.
Assistance with household chores like shopping, cleaning, or cooking.
Your plan will not cover a full-time, 24-hour caregiver in your home.
If you'd like additional coverage, consider getting HomeCare Insurance. Read Protection Plans Overview to learn more.